Stack W A, Long R G, Hawkey C J
Division of Gastroenterology, University Hospital, Queens Medical Centre, Nottingham, UK.
Aliment Pharmacol Ther. 1998 Oct;12(10):973-8. doi: 10.1046/j.1365-2036.1998.00396.x.
Recent evidence suggests that the immunosuppressive drug cyclosporin may be of benefit in treating patients with severe colitis who are steroid resistant. Although cyclosporin appears to be effective in reducing colectomy rates in the short term, few data are available on the long-term follow-up of such patients.
To investigate the short- and long-term outcome of patients with severe steroid-resistant ulcerative colitis treated with cyclosporin who were otherwise being considered for colectomy.
Twenty-two patients with severe steroid-resistant exacerbations of ulcerative colitis who were being considered for colectomy were treated with cyclosporin (4 mg/kg i.v.) daily for 7 days followed by oral treatment (6 mg/kg/day) if colectomy was avoided.
Twenty of 22 patients (91%) avoided colectomy during their initial hospital admission. With a mean follow-up period of 39 months (range 31-59), eight of these patients have subsequently relapsed and required colectomy and 12 patients have avoided colectomy (53%). Of the 12 patients avoiding colectomy, seven have successfully been weaned on to azathioprine while five are maintained on an aminosalicylate alone. None of these long-term responders require maintenance corticosteroids. The main side-effects during treatment with cyclosporin were headaches (six patients, 27%), paraesthesia and tremors (four patients, 18%) and hypertension (four patients, 18%). Two patients developed renal impairment on cyclosporin which resolved on lowering the dose. In no case was cyclosporin discontinued because of an adverse reaction. No clinical or laboratory features could be identified that predicted which patients treated with cyclosporin would later require colectomy.
This study shows that cyclosporin is a viable alternative to emergency colectomy in severe ulcerative colitis in the short term. Although these benefits are not maintained in all patients, more than half were found to avoid colectomy in the longer term.
最近的证据表明，免疫抑制药物环孢素可能对治疗对类固醇耐药的重症结肠炎患者有益。尽管环孢素在短期内似乎能有效降低结肠切除术的发生率，但关于此类患者长期随访的数据却很少。
研究接受环孢素治疗的重度类固醇抵抗性溃疡性结肠炎患者的短期和长期预后，这些患者原本被考虑进行结肠切除术。
22例因溃疡性结肠炎严重发作且对类固醇耐药而被考虑进行结肠切除术的患者，接受环孢素（静脉注射4mg/kg）每日治疗7天，若避免了结肠切除术，则后续给予口服治疗（6mg/kg/天）。
22例患者中有20例（91%）在首次住院期间避免了结肠切除术。平均随访期为39个月（范围31 - 59个月），其中8例患者随后复发并需要进行结肠切除术，12例患者避免了结肠切除术（53%）。在这12例避免结肠切除术的患者中，7例已成功停用环孢素并改用硫唑嘌呤，5例仅维持使用氨基水杨酸制剂。这些长期缓解的患者均无需维持使用皮质类固醇。环孢素治疗期间的主要副作用为头痛（6例患者，27%）、感觉异常和震颤（4例患者，18%）以及高血压（4例患者，18%）。2例患者在使用环孢素期间出现肾功能损害，降低剂量后恢复。无一例因不良反应而停用环孢素。无法确定任何临床或实验室特征可预测哪些接受环孢素治疗的患者后来需要进行结肠切除术。
本研究表明，环孢素在短期内是重度溃疡性结肠炎紧急结肠切除术的可行替代方案。尽管并非所有患者都能维持这些益处，但发现超过一半的患者在长期内避免了结肠切除术。
